More than half of MA students arrive taking prescribed psychotropic medications—usually to address deflated or labile mood, academic problems with focus, concentration or impulsivity, or to relieve anxiety or other psychiatric symptoms—or all of the above. Some students also arrive on medications prescribed in the past for somatic problems, e.g., hypo-thyroidism, or acne. To keep all prescriptions up to date, clinically, becomes a problem in a residential school far distant from doctors who prescribed them, who cannot easily re-examine a young patient.
For this reason our medical director, John McKinnon, MD reviews medical histories and current prescriptions soon after enrollment for every student, and he orders on-going medications through Medical Arts Pharmacy in Kalispell. His orders produce a weekly delivery of pre-packaged doses that our nurse or other staff dole out carefully—for students to take in the morning, at noon and or in the evening—and document.
At enrollment, parents consult with Dr. McKinnon to establish continued prescriptions, and in general, we make few changes at this time. Given the turmoil associated with a student’s arrival, clinical results of such changes would be very difficult to evaluate. For this reason Dr. McKinnon usually continues previous prescriptions, which we know competent physicians have ordered, and he makes warranted changes only after a student has settled in and has a relationship with Dr. McKinnon, who will have followed his progress over time. For psychotropic medications, Dr. McKinnon himself consults with students and parents. For medications prescribed for somatic problems, he and our nurse may discuss orders with home doctors or arrange for consultations with Montana physicians.
All prescribed medication ordered for staff distribution to students at the ranch or at the Sky Houses are prepackaged each week at Medical Arts Pharmacy in Kalispell. Unfortunately, a local pharmacy by law cannot re-dispense medications supplied by other pharmacies or provided in large quantities by bulk dispensaries that insurance companies may favor. Albeit the out-of-pocket cost to parents may be greater, or reimbursement may require parents to negotiate with insurance companies, this controlled prepackaging is the price for our ability to accept students taking prescription medication in a therapeutic boarding school (as opposed to a hospital) and for our staff legally to distribute them at the ranch. For equally compelling logistical and safety reasons, we have had to limit the vitamins/supplements we can make available at the ranch to a preset list from which we routinely provide for students with parents’ approval (see list of OTC and vitamins/supplements in application materials).